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What does the word coxarthrosis mean?
The hip connects the ball-shaped head of the femur to a socket in the pelvis. A layer of cartilage facilitates sliding; a capsule surrounds the joint and muscles support it. Coxarthrosis means osteoarthritis of this joint. Cartilage, bone and other tissues may change. It’s not just a mechanical part that wears out with every step.
A joint can remain useful despite these changes. Pain also depends on tissue sensitivity, strength, sleep and daily load. These elements do not make the pain imaginary. They explain why two people with similar images can have very different difficulties, and why improving function is still possible without changing the x-ray.
Understand the picture
One joint, several elements
Head of the femur
It moves within the hip socket.
Cartilage and joint
Osteoarthritis can change several tissues, not just one layer of cartilage.
Muscles
Their ability contributes to useful actions, even if the x-ray does not change.
How can discomfort present itself?
The pain is often located in the groin, but it can reach the thigh, buttock or even the knee. Stiffness when starting, difficulty turning or putting on a shoe can attract attention. Some people are especially bothered after a long walk; others are at night or after sitting for a while.
These signs are not enough to confirm osteoarthritis. Pain on the side of the hip may come from the tendons, and pain that goes down with tingling may have another origin. Describe what you can no longer do, when the discomfort appears and how it develops. This adds more to the clinical assessment than a single pain figure.
Why does it appear, and can we predict what happens next?
Age, certain injuries and the shape of the joint can contribute to the development of osteoarthritis. Dysplasia, for example, corresponds to insufficient coverage of the head of the femur. Weight and certain repeated loads can also be involved, but it is rarely possible to attribute the symptoms to a single cause in a person.
You did not necessarily cause your osteoarthritis by poor posture or ordinary activity. The evolution is not a regular slope: more sensitive periods can alternate with easier periods. A review allows you to identify what can be changed now. It does not make it possible to announce with certainty the date of an operation or the speed of a possible worsening.
What can the exam and images show?
The professional is interested in your walking, mobility, strength and difficult tasks. He can also examine the back and the knee. In a typical situation, a clinical assessment may be sufficient to guide treatment. Imaging is not a necessary step before starting any advice or exercise.
An x-ray may be ordered if the presentation is unusual, if another cause is suspected, or to prepare for a specialist decision. An MRI is generally not the first test for typical osteoarthritis. Ask what question the test should answer and whether its result will change care. The report describes structures; it does not alone measure your pain, your independence or the benefit of a prosthesis.
What changes require medical advice?
Severe pain after a fall, a new inability to bear weight on the leg, a painful hip with fever or a deteriorating general condition should not be automatically attributed to osteoarthritis. A rapid assessment is necessary. Unusual sudden pain without falling also merits attention, especially if walking becomes difficult.
Also consult if persistent pain significantly disrupts sleep, if walking is noticeably reduced or if the agreed measures no longer help you. Isolated nocturnal pain can accompany several disorders; its context matters. Unexplained weight loss, known cancer or other new symptoms should be reported. The warning signs guide specifies the situations where you must act without delay.
Chapter sources [3]
What treatment can be offered?
The treatments combine information, adapted activity and exercises chosen for your needs. Support with weight management can be discussed if it is relevant to you, without making weight loss a condition for receiving help. A cane or other support can make some outings easier; its choice and adjustment are made with the professional.
The doctor or pharmacist can discuss medications based on your other illnesses and treatments. Anti-inflammatories are not suitable for everyone. An injection can sometimes be proposed, but its objective and expected duration of effect must be explained. Manual techniques can be a complement to an active program; they do not restore cartilage. Be wary of a promise of guaranteed regeneration or permanent disappearance of pain.
In everyday life
Take the neighborhood walk again
Define
Choose a route and a difficulty that you want to improve.
Adjust
First reduce the distance or slope if the reaction is too strong.
Compare
Observe the walk and the next day before adding duration.
How does physiotherapy become practical?
The program is based on a personal objective: to get up more easily, walk to the store or resume a leisure activity. The physiotherapist chooses mobility, strength and endurance movements, then adapts their difficulty. He also observes how to carry out the task, useful aids and the constraints of your day.
You should know what you are training and how to judge the reaction. A slight and temporary discomfort does not always mean giving up an exercise. On the other hand, significantly stronger pain that persists, a new limp or deteriorating function requires adaptation. There is no single program suitable for all osteoarthritic hips. The three movements in the Exercises section are possible starting points, to be selected with you.
Walking, working and sleeping: practical choices
For walking, first find a distance that you can repeat with an acceptable response. Two shorter outings may be easier than one long one. If a hill or a staircase significantly increases the discomfort, temporarily modify the route. Cycling or an activity in the water can offer another way to move if you tolerate them.
At work, alternate tasks when possible and move frequently used objects closer together. For shoes, sit down and use an aid if you need to strain the hip. To sleep, try a support that improves comfort, for example between the knees in a lateral position. There is no ideal mattress or position for everyone. Remember what makes your night easier without creating further pain.
How to progress without alternating complete stoppage and excess?
Choose a benchmark activity and simply note its duration, difficulty and how you feel the next day. If it gets easier, increase just one thing: a few minutes of walking or a little more resistance, for example. The exact number depends on your starting level. A difficult week does not necessarily mean that the joint has become more damaged.
Example: if a big outing requires you to stay almost still the next day, reduce its length and maintain regular activity during the week. If short outings remain well tolerated, gradually resume the distance. A lasting change in pain or ability should be reviewed. The goal is usable progression in your life, not daily performance on an exercise chart.
When should you discuss hip replacement?
A surgical consultation may be considered when pain, stiffness or limitation significantly affects your quality of life and non-surgical care does not provide enough help or is not suitable. The decision combines your priorities, the medical assessment and a discussion of the benefits, risks and rehabilitation.
You don't have to wait until you don't walk at all to ask the question. Conversely, a markedly changed X-ray does not require surgery if the situation remains acceptable. Prepare specific examples of what limits you and what treatments have been tried. The prosthesis guide describes preparation of the home, instructions after the procedure and the resumption of independence.
Your questions
Can exercises repair cartilage?
They are not advertised as cartilage repair. Their aim is to improve strength, useful mobility, endurance and activity management. So you can gain function even if a future x-ray looks similar. The result varies from person to person.
Chapter sources [5]
Should I avoid walking because my hip is arthritic?
Not automatically. Appropriate walking is one of the ways to stay active. Its duration, terrain and breaks are adjusted according to your reaction. A sudden inability to bear weight on the leg or pain after a fall first requires a medical evaluation.
Why do I have knee pain when the problem may be in my hip?
The nervous system can cause pain to be felt at a distance from its source. This is one reason to examine the hip when a knee hurts. This does not allow us to conclude that all knee pain comes from the hip; the examination remains necessary.
Chapter sources [1]
How many sessions will it take?
The number depends on the objectives, your difficulties and your progress. A schedule should plan what you do between sessions and when to take stock. Neither a fixed package of sessions nor the indefinite continuation of passive care guarantees a result.
Chapter sources [5]
Sources and references
- [1] Assurance Maladie — Arthrose de la hanche
- [2] IQWiG — Hüftarthrose
- [3] NHS — Hip pain in adults
- [4] Royal National Orthopaedic Hospital — Hip dysplasia in teenagers and young adults
- [5] NICE NG226 — Osteoarthritis
- [6] NHS Inform — Exercises for hip problems
- [7] NICE NG157 — Joint replacement
Text updated on
Medical review: awaiting Hasib Selimovic.